ComplaintsforCentene Corp
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Complaint Details
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Initial Complaint
07/07/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Please take a look at the uploads. I paid over a $1,000. on shipping records to Centene because they would only accept a hard copy during the appeal, however during the audit I could only submit digitally. I incurred thousands more in attorney fees. I did the work of providing psychological service to children in foster care, with fidelity often driving to their home all across the greater Houston area. It is an unfair practice to totally negate the work due to paperwork/therapy notes. Centene/Superior has yet to clearly provide the expectations, despite my numerous requests. My paperwork/therapy notes have never been questioned in 23 years of practice by attorneys, judges, licensing, CPS, Child Advocates, Case-managers... Once they demanded more documentation, I collected what I was able under the 30day (not 30 business day demand) while coping with a new diagnosis of Breast Cancer. Not fair.Business response
07/10/2023
July 10, 2023
Better Business Bureau
Attn: Dispute Resolution Department
******* ************ ***** ******* **** ** ******* ** ***** ******* ****** ************
Re: ******* ************
Complaint ID: ********
To Whom It May Concern,
Superior HealthPlan received your grievance on July 10, 2023, concerning ******* ************,
BBB Complaint Case ********. Due to federal and state privacy and confidentially regulations,
we are unable to disclose any protected health information, including eligibility, claims, and
billing information, with anyone other than our members or their authorized representatives.
We will be sending a detailed response directly to Dorothy Florian-lacy addressing BBB
Complaint Case# ********. A member of the Superior HealthPlan escalation team will contact
you within 2 business days.
Sincerely yours,
Executive Response UnitInitial Complaint
07/06/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I'm. Critically I'll HomeBound. Patient. with. Iron. Deficiency Anemia, Asthma, COPD, Shortness of Breath, Hiatal Hernia, Ulcerative Colitis. and many. more. Chronic. Diagnoses. My Sunshine Health. Plan. for. No. Apparent Reason. Cut. my. Personal. Home Care. Allowance for 17 Hours. and DisApprove Or. Deny. Alivi. Transportation. Rides Over. 100 Miles. for. an Appointment for a. Special. Pulmonologist. Lung. Surgeon. for Bronchial. ThermoPlasty. Surgery in Gainesville Florida and. Deny. the. Mileage. Gas Reimbursement. Trips And. I've. got. a RunAround. between Alivi. and. Sunshine. Health. with. No. End. to. Stop.Business response
07/07/2023
Sunshine Health Plan received your grievance on July 7, 2023, concerning ******* *****, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information,
including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. We will be sending a detailed response directly to ******* ***** addressing BBB Complaint Case# ********.
A member of the Sunshine Health Plan escalation team will contact you within 2 business days.
Sincerely yours,
Executive Response Unit
Initial Complaint
06/16/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Stop calling me. I have been asking for almost 2 months yet I continue to get calls for Medicare. First I am not old enough for Medicare and second I train th4 agents making you calls to try to sell Wellcare Medicare insurance.Business response
06/19/2023
Better Business Bureau
Attn: Dispute Resolution Department
***** ****** *** ******** **** ******** ** ***** ************
Re: ***** ******
Complaint ID: ********
To Whom It May Concern,
Centene received your grievance on 6/16/2023 concerning ***** ******, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. We will be sending a detailed response directly to ***** ****** addressing BBB Complaint Case# ********. A member of the Centene escalation team will contact you within 2 business days.
Sincerely yours,
********* *****
Initial Complaint
06/11/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Resolved
Centene owns WELLCARE insurance company. I was a Wellcare member untill 12-31-2022. My membership # with them is: 21692084.I was a patient of a medical provider that was in their network in 2022.I received medical treatment on or about 3-7-2022 Wellcare paid other claims associated and approved for and by the same medical facility--but refused to pay the one claim for $292.12.Medical provider says they billed it 13 times and Wellcare rejected it each time even when it was authorized.I started getting ******* notices several months ago. I tried to get explanation from the medical provider and they said Wellcare blamed them for the rejection (?????)I started calling Wellcare and their customer service is almost impossible to deal with, but finally reched a man who said he medical provider was supposed to get paid from some other source and he would follow up and call me back.I have been unsuccessful in getting anyone on the phone again at Wellcare and when I do, they tell me they can't find my records.I have been unable to make contact with Wellcare or Centene due to the fact that they have all their management teams and corporate officers hidden behind tons of screenings. No way for a normal human to make contact. The medical provider is now threatening me with collections an/or credit.My complaint is that Wellcare/Centene is doing their best to get out of paying a legitimate medical bill, leaving me out in the cold.Business response
06/12/2023
Hello, Please see attached letter. Thank you!
Better Business Bureau
Attn: Dispute Resolution Department
*******************
1014 *************.
*******, ** 77375
************
Re: *******************
Complaint ID: ********
To Whom It May ******************** received your grievance on 6/11/2023 concerning *******************, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. We will be sending a detailed response directly to ******************* addressing BBB Complaint Case# ********. A member of the WellCare escalation team will contact you within 2 business days.
Sincerely yours,
Executive Response UnitCustomer response
06/13/2023
Better Business Bureau:
I have reviewed the response made by the business in reference tocomplaint ID ********, and find that this resolution is satisfactory to me.
Sincerely,
*******************Initial Complaint
06/06/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I needed an MRI for my back I have bad sciatica pain. They were supposed to do injections. They denied the claim stating I needed to either have phystherapy or chiropractic care. I can barely walk the pain is so bad. How the hell am I going to do physical therapy. And chiropractic care They mess you up worse . This is the worst insurance company everBusiness response
06/08/2023
Attn: Dispute Resolution Department
***** ****** *** ******** **** ******** ** ***** *************
*** ***** ****** ********* *** ********
To Whom It May Concern,
Ambetter received your grievance on 6/6/2023 concerning ***** ******, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. We will be sending a detailed response directly to ***** ****** addressing BBB Complaint Case# ********. A member of the Ambetter escalation team will contact you within 2 business days.Initial Complaint
03/09/2023
- Complaint Type:
- Billing Issues
- Status:
- Answered
Someone signed me up unbeknownst to me for this insurance. i didn't know this happened. I was paying for ********* ********** while someone signed me up for this. I was a State employee and was paying my employer for this.Business response
03/15/2023
Please review the attached acknowledgement letter.
******** **** **** ***** ****** **** received your grievance on 03/10/2023 concerning **** ********, BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives.
An ******** representative reached out to **** ******** on 03/14/2023 but was unable to speak with her and left a voicemail. We will be sending a detailed response directly to **** ******** addressing BBB Complaint Case # ********. If you have questions, please call us at ************** ******** ****************
Initial Complaint
01/05/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I went through the ****** *********** to obtain insurance for the year 2023. On December the 15th I made my first payment to ********, over the phone, using my debit card. They took $113.70 on December 15, 2022. My checking account shows the withdrawal coming from "*** * ******** * *********** *********** **". They are not trying to reconcile this at all. They keep giving me the run around, saying they will escalate this and send it to billing. But nothing has happened and every time I call I have to start my story all over again. I want my money back and for these people to be exposed for what they are doing to people like myself. They never gave me any insurance cards and every time I called they said my plan was terminated and they'd try to reinstate it. After two weeks of waiting for them to reinstate my insurance plan I had to go to **** ***** *** **** ****** and get another insurance plan. ******** claims that they did not receive my payment but my checking account shows it differently. I asked for a refund and was told I had to cancel my plan through the *********** in order to receive a refund. The lady at the *********** asked if I was sure I wanted to do that because it showed me being covered with the ******** Gold plan, that I paid for, through January 31, 2023. She said if I canceled my plan it would take 30 days to take effect and I would not get a refund. She suggested I call back and ask for my ID cards since I wasn't covered by **** until February 1, 2023. When I called back about my cards they said I did not have a plan but yet they took my money. I have been hung up on so many times and no one is helping me get my money back. I will never use them for insurance. I think it's a scam.Business response
01/09/2023
To Whom It May Concern,
******** from ******** ***** **** ****** **** received your grievance on 01/05/2023 concerning ***** *****
BBB Complaint Case# ********. Due to federal and state privacy and confidentially regulations, we are unable
to disclose any protected health information, including eligibility, claims, and billing information, with anyone
other than our members or their authorized representatives. We will be sending a detailed response directly to
***** **** addressing BBB Complaint Case# ********. If you have questions, please call us at ******** of
North Carolina.
Respectfully,
***** ****
Member RelationshipInitial Complaint
12/05/2022
- Complaint Type:
- Delivery Issues
- Status:
- Answered
Member name:****** ****** Member ID# *********** Member DOB: 06/07/1966 Name of Drug: SUBOXONE MIS 12-3MG Full Description of the issue : November 22 2022 The pharmacy stated my rx was too early to be filled while they only gave me 26 pills. The pharmacy stated they gave me 56 films i want someonet to process an investigation regarding my refill. I reached out to pharm they stated. they already pull the cameras 56 film were provided to member.Business response
01/13/2023
January 13, 2023
Better Business Bureau
Attn: Dispute Resolution Department
****** ****** *** ***** ****** ******* **** * ********** ** ********** ********* *** ********
To Whom It May Concern,
********* ********** *********** received notice from your office of a complaint on December
5, 2022, concerning our member, ****** ******. Due to federal and state privacy and confidential
regulations, we are unable to disclose any protected health information, including eligibility,
claims, and billing information, with anyone other than our members or their authorized
representatives. However, we can confirm that we have investigated this matter.
Our Pharmacy team worked directly with Walgreens Pharmacy regarding this member’s
prescription fill. The issue has been resolved and the member is on track with her medication.
Thank you for bringing this matter to our attention.
Respectfully,
****** ** ******** ****
Vice President, ComplianceInitial Complaint
10/15/2021
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
Contracted with Centene for Health Insurance through one of its agencies. Centene's agent promised certain coverages at the time of entering the contract. After consumer provided consistent monthly payments to Centene, Centene refused to provide promised coverages, effectively kicking consumer off medications and treatment, refusing promised medical coverage, which caused and continues to cause consumer severe life threatening damages.Business response
10/22/2021
Please see attached response to Complaint #********.
To Whom It May Concern,
Ambetter from Home State Health received your grievance on October 18, 2021 concerning ***** ***********, BBB Complaint Case #********. Due to federal and state privacy and confidentially regulations, we are unable to disclose any protected health information, including eligibility, claims, and billing information, with anyone other than our members or their authorized representatives. We will be sending a detailed response directly to ***** *********** addressing BBB Complaint Case #********. If you have questions, please call us at 1-855-650-3789 (Relay 711.)
Initial Complaint
09/14/2021
- Complaint Type:
- Billing Issues
- Status:
- Answered
Centene filed a claim with Aetna Ins. for services they DID NOT PROVIDE. The medical appointment was 4/27/2021 at Swedish medical and was already paid months ago by Coordinated Care. Somehow Centene obtained information about my appointment and recently made a claim thru Aetna (I picked up Aetna coverage in July as part of the COBRA subsidy in the American Rescue Plan). But this coverage was backdated to 4/1/2021. I have NEVER had any relationship with this company whatsoever. Furthermore since this claim was already paid months ago AND Centene provided NO SERVICE this is nothing short of insurance fraud.Customer response
09/14/2021
I'm already certain that Centene is engaging in fraud by submitting a claim to Aetna for services which they never in any way provided. I looked at their website; they are not even a medical provider. I have no idea what their business is.
As I already mentioned the appointment was at Swedish Medical in Seattle and the claim was already submitted and paid by Coordinated Care months ago.
I'll wait to see if Centene replies but whatever they say - if anything - does not matter to me. I don't know how they could have gotten any information about me so I would appreciate it if you could direct me to any agencies that investigate fraudulent activity of this nature.
***Business response
09/21/2021
Good morning, we forwarded the issue to our Special Investigation Unit for review on this alleged fraud allegation/compliant, after their review, they advised: The complainant is not a member, no paid claims were found. thank you.
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Customer Complaints Summary
16 total complaints in the last 3 years.
7 complaints closed in the last 12 months.